Effect of cisapride on relapse of esophagitis

Abstract

The effect of a prokinetic agent, cisapride, on the relapse of reflux esophagitis was investigated in a randomized, double-blind trial conducted in 443 patients whose esophagitis had previously been healed with an acid antisecretory drug. Patients received cisapride, 20 mg at night, cisapride 10 mg twice daily, or placebo for 12 months or until endoscopic relapse was confirmed endoscopically. In 88% of all patients (respectively 133, 132, and 124), endoscopic data were available at discontinuation of treatment. In comparison with placebo, the two cisapride regimens prolonged both the time to endoscopically confirmed relapse (Kaplan-Meier analysis; P = 0.001) and the time to symptomatic relapse (P = 0.012). The life-table endoscopic relapse rates at 12 months were 51% for placebo, 32% for cisapride 20 mg at night (P = 0.005), and 34% for cisapride 10 mg twice daily (P = 0.02). Patients with more severe esophagitis before healing relapsed more rapidly during maintenance therapy, regardless of the treatment regimen. Adverse events were infrequent in all three groups. These findings indicate that maintenance treatment with the prokinetic drug cisapride prevents the relapse of esophagitis after it has been healed by acid antisecretory therapy.

Gastroesophageal Reflux Disease

“…Symptom relief can be achieved with cisapride in nearly 60% of patients when 10 mg is given 4 times daily and this is equal to H 2 receptor antagonists when the two are compared head to head. Though US trials have been disappointing, trials from Europe show acute healing, and 1‐year remission rates are equal to H 2 antagonists when they are compared head to head 46 . Recent studies suggest that comparable symptom relief can be achieved with 20 mg BID, a dose that will increase compliance 47 .…”

Effect of Cisapride on Gastroduodenal Reflux and Gall Bladder Motility in Patients with Gallstones

“…Previous studies also reporting adverse events of cisapride found diarrhoea to be the most common. Tytgat et al [33] found diarrhoea was reported by 9% of the patients taking cisapride and in another study diarrhoea was reported in 4% of cisapride recipients and in 3% of placebo recipients [34] and in 3–6.5% in large non-comparative studies [35, 36, 37], and in a 12-month study by Blum et al [38] diarrhoea occurred in 11 and 4% of cisapride and placebo recipients respectively (p < 0.05). This increased stool frequency during cisapride treatment is not caused by malabsorption of water, fat or bile acids, but seems to be the consequence of a direct motor effect [39].…”

Gastroesophageal Reflux Disease (GERD): Current Agents and Future Perspective

“…However, neither regimen has been demonstrated to be effective with higher grades of esophagitis [26]. Cisapride (10 mg twice daily or 20 mg at bedtime) prevents relapses in patients with mild esophagitis [27,28].…”

“…The principles of treatment are the same as for uncomplicated esophagitis with the proviso that it is more severe disease and is therefore likely to require maintenance therapy with IBP or anti-reflux surgery. Cisapride (10mg twice daily or 20 mg at bedtime) also prevents relapses in patients with mild esophagitis [28]. However, if symptoms recur shortly after treatment has been stopped, maintenance therapy with omeprazole 20 mg daily is highly effective [39,59].…”